Annexure “C” UNIVERSITY OF SINDH, JAMSHORO, SINDH, PAKISTAN FACILITATION CELL FOR GROUP HEALTH INSURANCE _____________________________________________________________________________________________ Tender: Medical/Health Care Facilities for employees & their dependents of University of Sindh for the year 2014-2015. Name of Insurance Company (Bidder):_________________________________________________ Gross premium for 12 months:_______________________________________________________ Hospitalization & day care benefits covered as per TOR of University of Sindh (enclosed here with) as under: PARTICULARS CATEGORY OF EMPLOYEES “A” CATEGORY OF EMPLOYEES “B” Annual limit per insured person except parents (without any constraints of number or types of ailments and confinements) Scope of Health Facilities Required: Rs. Rs. Hospital Care (Including Surgeries:) Required medical facilities include: Daily room and board charges, operation theatre charges, surgeon fee, Anesthetist fee, consultant’s fee, Medicines and drugs, Diagnostic tests including at Advance Radiology Centre ,Karachi, Blood and Oxygen supplies, MRI, CT SCAN, Angiography, Echo, Miscellaneous charges ( Patients meal, local road ambulance charges, etc) lipid profile, ETT Medical care for Prolonged/serious ailment: Required full medical treatment for following disease with the hospital; (a) Cancer (b) Aids (c) Renal failure (Kidney failure)/Dialysis and Transplant (d) Heart Disease/ Hypertension (Cardio Vascular Disease) By pass Angioplasty and pace maker installation (e) Diabetes (f) Asthma/ T.B (g) GVP/Stroke/Paralysis (h) Chronic Hepatitis B & C and Liver diseases (i) Burns injury ( over 25%) (j) Rheumatoid/ Arthritis, Oste Arthritis / Total knee / Hip replacement (k) Chronic Bowel Disease like peptic Ulcer (l) Ulcerative Colitis, Crohh’s disease (m) Eye, ENT and Dental Care) Any other disease declared by the Specialist/ Consultant as serious/ prolonged ailment to the satisfaction of the University of Sindh (n) Dermatological diseases (except cosmetics) (o) Day Care OPD. Annual Limit for each of parents (without any constraints of number or types of ailments and confinements) Rs. Rs. 50% increase in basic hospitalization limit, if the hospitalization is due to an accident. Daily Room Rent to be covered from annual limit Specialized investigation to be covered out of annual hospitalization limit Yes / No Yes / No Rs. Rs. OR Full cover Rs. Rs. OR Full cover *Rs. **Rs. ***Rs. *Rs. **Rs. ***Rs. *Rs. **Rs. ***Rs. *Rs. **Rs. ***Rs. Rs. Rs. Maternity expenses limit: *Normal at Hospital **Cesarean at Hospital ***Dai (Home Nurse) charges Delivery conducted at home Dental treatment facility: * Root Canal filling ** Bridging one tooth between two ( total 25 cases) *** Accidental cases to be covered from annual hospitalization limit. Circumcision of baby boy covered from annual hospitalization limit. Liver Treatment Diabetics Ortho fracture or any emergency: visit to OPD + investigation + medicine Fund (Pool Limit) Executive Check-up “B” package at Agha Khan Hospital Karachi Personal Accident Cover to employee (death only) Date:________________ Name: __________________________ Signature of Authorized representative & Stamp. One million One million 100 cases of insured persons recommended by University of Sindh